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ICC1 > Extracranial, Renal, thoracic outlet and Mesenteric > Flashcards

Extracranial, Renal, thoracic outlet and Mesenteric Flashcards

1
Q

what is a stroke ?

A

defined as a neurological deficit that lasts more than 24 hours

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2
Q

what is a transient ischemic attack ?

A

a neurological deficit that lasts less than 24 hours

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3
Q

what is the main cause of carotid territory ischaemic stroke ?

A

thromboembolism

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4
Q

what are the carotid territory symptoms?

A

hemisensory/motor signs , dysphagia and amaurosis fugax

FAST

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5
Q

what investigations would be taken forcarotid occlusiive disease?

A

lab investigations: CBC, Lipid Profile, coagulation profile, urea and creatinine and glucose
echo
duplex
CTA or MRA could be used pre-operativley

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6
Q

what is the first line of investigationin carotid artery stenosis?

A

duplex

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7
Q

what is the most appropriate management for carotid disease ?

A

BMT
CEA/CAS
timing is important

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8
Q

what are the complications of carotid endarterectomy?

A

stroke
bleeding and hematoma formation
cranial nerve injury (12,10,9)
hypoglossal - tongue deviation
hoarsness of voice - vagus nerve affection
difficulty swallowing - glossopharyngeal

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9
Q

what is the most common pathological condition of the renal arteries ?

A

atherosclerotic stenosis

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10
Q

what are the management options for atherosclerotic renal vascular disease ?

A

medical therapy and may be considered for re vascularisation by either endovascular or surgical means

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11
Q

what are the options for renal replacement therapy ?

A

haemo-filtration
peritoneal dialysis
heamodialysis
transplantation

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12
Q

what type of access is made for renal replacement therapy patients ?

A

arteriovenous fistula

arteriovenous graft

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13
Q

how long does a native fistula take to mature

and how long does a graft take to mature ?

A

6 months

a graft takes 6-8 weeks

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14
Q

when should a native fistula be created ?

A

6 months before need

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15
Q

what is the rule of 6 in the ideal AVF conduct ?

A

flow rate of at least 600ml/min
should lie less than 6mm below the surface of the skin
minimum diameter of 6 mmi

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16
Q

ideally how many dialysis needles can be placed with AVF ?

A

2 dialysis needles

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17
Q

what are the common sites for an AVF ?

A

wrist radiocephalic
wrist ulnobasilic
brachiobasilic
brachiocephalic

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18
Q

what are the access complications ?

A 
stenosis 
thrombosis
infection 
failure to mature 
steal syndrome 
high flow cardiac failure 
aneurysm formation
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19
Q

where is the thoracic outlet?

A

region at the top of the rib cage between the base of the neck and the axilla

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20
Q

what are the contents of the thoracic outlet ?

A

brachial plexus

subclavian vessels

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21
Q

which gender is TOS more common in ?

A

women

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22
Q

what are the causes of thoracic outlet syndrome ?

A

anatomical factors such as a cervical rib
fibrous bands
repetitive injuries

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23
Q

what is the most common congenital abnormality causing TOS?

A

fibrous bands which transverse the thoracic outlet

24
Q

what are the three forms of TOS ?

A

neurogenic TOS
Arterial TOS
Venous TOS

25
Q

what is the most common form of TOS ?

A

neurogenic

26
Q

what are the symptoms of neurogenic TOS?

A

symptoms in the ulnar nerve distribution
pain when raising the arm
paraesthesia on the medial side of the arm

27
Q

where does the pain radiate with neurogenic TOS ?

A

radiates to the axilla shoulder and back

28
Q

what tests provoke positive findings in neurogenic TOS ?

A

Adson test

Roos test

29
Q

what is the presentation of venous TOS ?

A

patient may present with cyanosis and arm swelling

30
Q

what is paget-schrotter syndrome ?

A

is a form of upper extremity DVT presennt with venous TOS

31
Q

what is the rarest form of TOS?

A

arterial TOS

32
Q

what is the presentation of arterial TOS ?

A

attacks of pallor, pain paraethesia

33
Q

what is the treatment of NTOS

A

conservative treatment
avoid repetitive ovberhead work
correct posture
strengthen shoulder elevating muscles

34
Q

when is surgery indicated with NTOS ?

A

if the conservative treatment failed to improve symptoms

or if the symptoms interfere with work or daily activities

35
Q

what are the treatment protocols for VTOS ?

A

thrombolysis and correction of anatomical abnormalities

first rib resection

36
Q

what are the treatment protocols for ATOS ?

A

thromboelectomy followed by excision of the cervical first rib

37
Q

how is the colon protected from ischaemia ?

A

marginal artery of drummond

38
Q

what are the types of mesenteric ischaemia ?

A

acute mesenteric ischaemia

chronic mesenteric ischaemia

39
Q

where is the problem when it comes to acute mesenteric arterial embolism ?

A

superior mesenteric artery

40
Q

where is the problem when it comes to acute mesenteric arterial thrombosis ?

A

at the vessel’s origin resulting in extensive bowel involvement

41
Q

what are the causes of nonocclusive mesenteric ischaemia ?

A

cocaine
vasopressors
hypotension

42
Q

what are the causes of mesenteric venous thrombosis ?

A 
hypercoaguability from protein s and c deficiency 
tumor 
infection 
pancreatitis 
venous trauma
43
Q

what are the signs and symptoms of acute form of mesenteric ischaemia ?

A

Abrupt severe abdominal pain
urgent need to have bowel movement
fever
nausea and vomiting

44
Q

what are the complications of acute mesenteric ischaemia ?

A

sepsis
irreversible bowel damage
death

45
Q

what lab results can show acute mesenteric ischaemia ?

A

raised WCC and lactate

46
Q

what imaging modality can be used to show acute mesenteric ischaemia ?

A

CTA or CT with IV contrast

47
Q

what are the signs and symptoms of chronic mesenteric ischaemia ?

A

abdominal pain that starts 30 minutes after eating
pain that worsens over an hour
pain that goes away within three hours

48
Q

what is the investigation of choice ?

A

CTA

49
Q

what can people with chronic mesenteric ischaemia suffer from ?

A

unintentional weight loss
fear of eating
acute on top od chronic mesenteric ischaemia

50
Q

what is the treamtment for mesenteric ischameia ?

A

revascularization

resection of non viable bowel

51
Q

what are the indications for CEA ?

A

more than 50% stenosis in symptomatic patients
more than 70% stenosis in asymptotic patients
fluctuating neurological symptoms , evolving TIA

52
Q

what is the best management if you have bilateral carotid stenosis ?

A

fix the more stenotic one first
if the same degree off stenosis , fix the dominant hand first

53
Q

when should we perform carotid stenting ?

A

previous CEA and high risk patients

54
Q

what is the first branch of thee ICA ?

A

ophthalmic artery

55
Q

what is the first branch of the ECA ?

A

superior thyroid artery

ICC1 (50 decks)

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